Leading Australian healthcare technology magazine Government Technology Review has featured Middlemore's use of CapPlan in its August 2010 edition.
New Zealand’s Middlemore Hospital has adopted capacity planning software and, as Simon Sharwood discovers, found that change management and a large screen TV were important ingredients in its efforts to increase the visibility of hospital occupancy.
Public Hospital staff are famously dedicated to providing excellent care, and at New Zealand’s Middlemore Hospital they can now do so with the confidence that the needs of staff and patients alike are carefully planned in advance.
Run by New Zealand’s Counties Manukau District Health Board, Middlemore Hospital has more than 800 inpatient beds, offers services for children, conducts surgery and operates a maternity service. The hospital’s main catchment area is South Auckland, a part of New Zealand with an exceptionally diverse population. More than half of the hospital’s patients are Maori, South Pacific Islander, Asian or Indian. This patient mix creates some complexity, as cultural concerns mean Middlemore does not place patients of different genders in shared rooms, a practise used elsewhere.
Decisive action was required because this mix of patients means Belinda Irvine, the hospital’s Capacity Planning Coordinator, has an unusually complex challenge to manage as she tries to bring visibility to hospital occupancy and forecast in advance to develop a hospital-wide bed plan aligned with demand.
In the past, those efforts were based on informed guesstimates. “We were using more of a manual approach to capacity planning,” she recalls. “We lacked the helicopter view of the hospital.” Middlemore staff tried to stay on top of things using a combination of spreadsheets and charts written on whiteboards, but reached a stage at which Irvine says “more advanced systems were required to assist in daily bed management.”
Software to assist with hospital capacity planning was an obvious solution and the hospital chose the CapPlan package from New Zealand’s own Emendo.
Initially deployed in a trial in the medical and surgical areas of the hospital, the software proved useful but also showed that the organisation needed a dedicated resource to ensure the application’s benefits could be realised.
“It was trialled on as a project and a couple of people were given responsibility,” Irvine says. “But they also had their normal jobs to perform. Overseeing CapPlan then fell to the manager of the Daily Operations Unit. The management of CapPlan was also in addition to her already busy role.”
These experiences convinced the hospital that it needed dedicated facilitation and system administration skills, and a champion for the capacity planning application.
Enter Irvine, an Australian with extensive experience operating patient administration systems and a business degree in health information management.
“I have performed the role of system administrator for every position I have ever held,” she says. “The management of health information systems has become my area of expertise.”
At Middlemore, however, Irvine has also had to become a change manager, a role she discovered would be important as she started to introduce CapPlan.
That realisation came despite the software quickly making a very positive impact around the hospital. “We have a dashboard that shows real-time visual presentation of hospital occupancy,” Irvine explains. “Any staff member can look at it. That sounds pretty basic, but it is not until you go to a meeting and see 20 doctors say ‘Wow! I can see what is going on instantly’ that you appreciate what a benefit it provides.”
From an operational point of view, that visibility allows better resource planning.
“CapPlan has provided us with a co-ordinated central place to plan beds, Our team in daily operations are one step ahead” and can use forecasts of demand for beds to plan where patients will stay and what staff will be needed to care for them. “Experienced staff have a gut feel, which the software confirms for them,” Irvine says.
Having a single, central, application that matches demand to human resources used across the hospital also helps to identify evolving needs. “The nursing staff have been able to see the gaps in a roster or see a particular ward that is overstaffed for no reason,” Irvine says. “It is about getting the right number of staff.” “It ensures money is spent when required,” she adds. “But let’s not assume we were it wasting before. On days when you do a lot of surgery you will have more staff rostered. It’s got to be about having the right staff at the right time, so sometimes if we spend more money to address patient needs that is okay.” Many staff understand these issues quickly. But getting the hospital ready so that more staff contribute to the application and understand its utility proved harder.
“Change management the biggest challenge: – that cannot be understated,” Irvine says. “Everyone has to want to contribute. I have never done more marketing, PR and education compared to previous positions held.”
That effort was necessary because when Irvine arrived at Middlemore the application had not been effectively maintained. Nor had educational efforts to explain the software to managers been extensive. “60% of my time has been spent teaching managers what the system and process can do and getting people on board who want to contribute to the process,” she says, as with managerial buy-in comes an impetus for other staff to use the system more often.“Without the input of the senior executives, the benefits would be so much less.” Along the way, Irvine found that large meetings did not work as an education tool. Instead, she found herself working one-to-one more often than not. While effective, this process means she finds “I repeat myself constantly.”
Technology has also helped. The hospital has placed a colossal plasma screen in its executive suite and uses it to display live data from CapPlan, a demonstration of the software’s power and of the way it has changed the way the organisation thinks about its efforts.
“We have been sitting in a meeting room next to that screen and people ask questions about it and discuss the metrics in front of the screen,” Irvine says. “And to see executives and senior people walk by and see what is going on in our hospital and ask questions, is quite exceptional I think.”